Sun Yangbai, Jiang Chaoyin, Li Qingfeng
Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, JiaoTong University, Shanghai, China.
PLoS One. 2017 Oct 10;12(10):e0186174. doi: 10.1371/journal.pone.0186174. eCollection 2017.
To compare the effectiveness and safety of combined intravenous and topical tranexamic acid with intravenous use alone in THA.
The electronic databases MEDLINE, EMBASE, BIOSIS, Cochrane central, and further adapted for Google and Google Scholar internet, last updated on Dec 30, 2016, were searched. Evaluated outcomes included total blood loss, transfusion rate, maximum postoperative Hb drop, and incidence of thromboembolic complications. The standard mean difference (SMD) or the relative risk (RR) was calculated for continuous or dichotomous data respectively. The quality of the trial was assessed, and meta-analyses were performed with the Cochrane Collaboration's RevMan 5.0 software.
Five RCTs with 457 patients were included. Combined TXA administration reduced blood loss (SMD, 1.39; 95%CI, 0.55 to 2.23; P<0.00001, I2 = 94%), hemoglobin decline (SMD, 0.84; 95%CI, 0.13 to 1.54; P = 0.01, I2 = 83%) and the need for transfusion (RR, 2.58; 95%CI, 1.59 to 4.18; P = 0.65, I2 = 0%) without increasing the rate of thromboembolic complications significantly (RR, 0.83; 95%CI, 0.27 to 2.54; P = 0.81, I2 = 0%).
The present study has emphasized that combined TXA administration can effectively reduce blood loss, hemoglobin decline and the need for transfusion without increasing the rate of thromboembolic complications.
比较静脉与局部联合使用氨甲环酸和单独静脉使用氨甲环酸在全髋关节置换术（THA）中的有效性和安全性。
检索电子数据库MEDLINE、EMBASE、BIOSIS、Cochrane中心，并进一步适用于谷歌和谷歌学术搜索，最后更新时间为2016年12月30日。评估的结果包括总失血量、输血率、术后血红蛋白最大降幅以及血栓栓塞并发症的发生率。分别对连续数据或二分数据计算标准平均差（SMD）或相对风险（RR）。评估试验质量，并使用Cochrane协作网的RevMan 5.0软件进行荟萃分析。
纳入了5项随机对照试验，共457例患者。联合使用氨甲环酸可减少失血量（SMD，1.39；95%可信区间，0.55至2.23；P<0.00001，I² = 94%）、血红蛋白下降（SMD，0.84；95%可信区间，0.13至1.54；P = 0.01，I² = 83%）以及输血需求（RR，2.58；95%可信区间，1.59至4.18；P = 0.65，I² = 0%），且未显著增加血栓栓塞并发症的发生率（RR，0.83；95%可信区间，0.27至2.54；P = 0.81，I² = 0%）。
本研究强调联合使用氨甲环酸可有效减少失血量、血红蛋白下降以及输血需求，且不增加血栓栓塞并发症的发生率。
